复杂性肾结石的治疗(附38例报告)

目的 探讨复杂性肾结石的各种治疗方法。方法 对38例复杂性肾结石分别采用观察治疗、ESWL、PCNL、ESWL＋PCNL、开放手术取石等方法。观察结石取尽率、尿路梗阻和肾功能及并发症情况。结果 全部病例恢复肾盂肾盏通畅，观察治疗4例，结石增大不明显；ESWL治疗4例，结石大部分击碎排出，梗阻解除，随访3～5年结石不增大，肾功能好转；PCNL或ESWL＋PCNL治疗16例19侧，4侧有2个肾小盏残留结石，另15侧完全取出结石。14例开放手术，11例行取石术，完全取净结石9例，残留小盏结石2例；肾切除3例，1例术前已有尿毒症，肾脏积脓，2例合并肾肿瘤。3例术前有肾功能不全者，2例术后肾功能恢复正常，1例无变化。出现尿瘘1例。全组病人无继发性大出血、切口感染等并发症。结论 复杂性肾结石应根据个体情况，选择个体化的治疗方法，才能取得较好的效果。

Treatment of complex renal calculi(report of 38 cases)

Objective] To summarize the therapic methods of complex renal calculi. Methods] 38 patients of complex renal calculi were treated by the watchful therapy, extracorporeal shock wave lithoripsy (ESWL), percutancous nephrolithotomy (PCNL), the combination of ESWL and PCNL, and open surgery. Results] All cases had recovered the unobstruction between renal calices and pelvis. Follow up 4 years, stones were not significantly increased in 4 cases of watchful therapy. Most of stones were crushed and fragments were discharged in 4 cases of ESWL, renal function were improved. 16 cases were underwent PCNL or PCNL and ESWL, four patient had residual stone in minor renal calies, other 12 cases were stone-free. 14 cases were applied open surgery, of 13 cases were carried out nephrolithomy, 11 cases were stone-free and 2 cases were residual stone in minor renal calies, one patient occured postoperative urinary fistula. One patient who had uremia complicated with pyonephrosis was underwent nephrectomy and postoperative hemodialysis. Three patients were preoperative renal inadequacy, 2 cases had improved renal function and one case was no changes after treatment. None patient complicated with postoperation secondary hemorrhea and infection of incisional wound. Conclusions] Treatment of complex renal calculi should select individuation method on individual pathogenetic condition, the method should be safe, effective and less complications, which most patients may get fine treatment.